ABSTRACT
OBJECTIVE: To summarize current knowledge about cesarean scar pregnancy and to provide a review about available managements of this serious pregnancy pathology. DESIGN: Review article. SETTING: Department of Gynecology and Obstetrics, District Hospital Náchod. RESULTS: Cesarean scar pregnancy is likely to be a result of impaired healing of the scar along with an increased affinity of trophoblast cells to extracellular matrix. A transvaginal ultrasonography represents a key tool in the cesarean scar pregnancy identification. The main goal of the cesarean scar pregnancy treatment is to preserve fertility. There are different approaches how to manage this pregnancy complication. A surgical treatment is characterized by an exstirpation of ectopic pregnancy. This approach makes a repair of lower uterine segment possible and it may improve a prognosis for subsequent pregnancy. However, the most common management is a conservative treatment with a methotrexate administration. Recently, an innovative mini-invasive treatment with a Foley catheter has been reported. A regular evaluation of ßhCG concentrations and a transvaginal ultrasound examination are used for a follow-up. Subsequent pregnancy is possible, yet it should be considered as a high-risk. CONCLUSION: Despite the fact the frequency of cesarean scar pregnancy increases, cesarean scar pregnancy still represents a rare but serious pregnancy pathology. In case of an early diagnosis, it should be managed with respect to preserve fertility.
Subject(s)
Cesarean Section , Cicatrix/etiology , Pregnancy, Ectopic/diagnosis , Adult , Female , Humans , Pregnancy , Pregnancy, Ectopic/surgeryABSTRACT
Nailfold capillaroscopy (NVC) is a simple and non-invasive method used for the assessment of patients with Raynaud's phenomenon (RP) and in the differential diagnosis of various connective tissue diseases. The scleroderma pattern abnormalities (giant capillaries, haemorrages and/or avascular areas) have a positive predictive value for the development of scleroderma spectrum disorders. Thus, an analytical approach to nailfold capillaroscopy can be useful in quantitatively and reproducibly recording various parameters. We developed a new method to assess patients with RP that is capable of predicting the 5-year transition from isolated RP to RP secondary to scleroderma spectrum disorders. This model is a weighted combination of different capillaroscopic parameters (giant capillaries, microhaemorrages, number of capillaries) that allows physicians to stratify RP patients easily using a relatively simple diagram to deduce prognosis.
